About This Interview
Independent, critical access, and rural hospitals often run supply chain with just two or three people. Mark Litton discusses how peer support, well-aligned supplier partners, and practical tools can help these teams solve problems and put improvements into action. This interview is adapted from Healthcare Supply Chain Best Practices Podcast No. 99 and edited for clarity, with revisions from Mark Litton.
- Host: Bob Yokl, President and Chief Value Strategist, SVAH Solutions; Managing Publisher, Healthcare Value Analysis and Utilization Management Magazine
- Co-host: Circe Calvin, CEO, Insights Consulting (strategic healthcare supply chain and value analysis advisory)
- Guest: Mark Litton, CEO, Howard Medical Company, an independent distributor bringing IDN-level services to independent, critical access, and rural hospitals; founder of the Independent Link Coalition, an AHRMM-backed peer network for supply chain leaders at independent hospitals
The episode grew out of an article Mark wrote for the magazine.
The Interview
Bob Yokl: As the leader of a distribution firm, how did you get so involved in your customers’ challenges beyond supplying products?
Mark Litton: You listen. Sit on the same side of the table, have lunch together, and the real day-to-day problems surface quickly. Then you ask what tools we can build to address them.
Smaller hospitals face many of the same challenges as large health systems, but with far fewer resources. A big IDN may have dedicated supply chain teams and established support networks. An independent, critical access, or rural hospital may have just two or three people in all of supply chain. The challenges are often similar across facilities, but the resources available to address them can be very different.
Circe Calvin: Is there a challenge that’s consistent across the partners you support?
Mark Litton: Several. We say they wear a lot of hats, but they work in complete isolation. They’re doing the job of ten people and often don’t know who their peers are. The recurring issues:
- Cost savings. A problem for everyone, but existential for small hospitals.
- Benchmarking. They don’t know how their pricing compares, and the technology to find out is expensive.
- Value analysis. Often one person runs the entire program across every stakeholder.
Bob Yokl: And they carry the same risks: vetting product efficacy, risk mitigation, all of it. Circe, you come from a large system. Can you imagine a one-person value analysis program?
Circe Calvin: At a large IDN in Idaho we face the same challenges. It’s a problem across every kind of system in the country.
Bob Yokl: Your article opens with a phrase leaders say almost word for word: “I wear a lot of hats, and I work in isolation.” Is there a story that embodies that, and how did it lead you to focus on this segment?
Mark Litton: Think about the recent supply disruptions, from Stryker to Baxter and others. A large facility has a process: secondary and tertiary suppliers, internal communications, dedicated teams. At a small hospital, it all lands on one person, the director of supply chain or procurement, with the CEO asking how they’ll fix it. They have nowhere to turn.
As for focus, I asked where we could provide unique value. After 15 years calling on healthcare in every vertical, working with supply chain leaders at independent hospitals has been the most rewarding and impactful work. They’re high-efficiency people. We still do backorder support for large IDNs, but this is where we choose to spend our time.
Circe Calvin: One of the hardest tasks during a major disruption is finding clinically equivalent substitutes. Do you help partners with that?
Mark Litton: Backorder supply has been our business for 20 years. We’re agile and proactive. When we hear about a problem, we go to the manufacturers with potential solutions and tell hospitals: this will probably hit you, here’s a product we believe is equivalent, we can get you a sample next day, let’s reserve it. Large systems have that process for their top thousand items. A two- or three-person team keeping the doors open usually doesn’t.
Bob Yokl: And there’s zero time, yet the standards stay high. You can’t lower standards in healthcare.
Mark Litton: That’s where people get frustrated. During disruptions, hospitals can face steep prices and offers from unfamiliar suppliers. They need partners they can trust. We only work with manufacturers we’ve personally vetted and the industry stands behind.
Bob Yokl: Trust is big. Smaller hospitals remember much longer.
Bob Yokl: Your article notes that some vendors don’t even pay reps commission on hospitals under 250 beds. What was your reaction, and how do you change something that’s an industry standard?
Mark Litton: Frustration. Some background helps here. The Independent Link is a subgroup under AHRMM dedicated to education and networking for supply chain leaders at independent, critical access, and rural hospitals. Nearly every vendor, technology, meetup, and group is designed for large systems. I went looking for an existing network for these leaders so I could join it. It didn’t exist, so we worked with AHRMM to create the first nationwide group focused solely on them.
We raised money for scholarships so leaders from small facilities could attend events like the AHRMM national conference. During vendor outreach, many said they don’t pay commission on hospitals under 250 beds. That shows how misaligned the industry is.
The opportunity is to align incentives around the needs these hospitals share. When those needs are visible across a community, suppliers and technology partners can better understand where to invest and how to make their solutions practical and affordable for smaller teams. We’re creating a way for hospital leaders to help shape the support built for them.
Circe Calvin: Many critical access hospitals are rural with no dedicated rep. Reps fly in from larger areas and support them almost as an afterthought.
Mark Litton: I hear that constantly. They don’t get love from the primaries or the GPOs. That’s not a knock; everyone in this industry works hard. But they get 40 inbound emails a day that aren’t designed for them. Give them an hour of focused attention and you can do amazing things.
Bob Yokl: The deck is stacked against them, and people don’t realize how many rural and critical access hospitals there are.
Mark Litton: The networking mechanism doesn’t exist even in cities. We work with independent safety-net hospitals in Chicago two miles apart whose supply chain leaders had never talked. Now they’re connected, and when problems hit, they can ask each other what they’re doing.
Bob Yokl: The stakes in your article are high, down to hospitals deciding whether to close labor and delivery to keep the doors open. For people outside healthcare, how does a two-person supply chain department affect decisions like that?
Mark Litton: Enormously, and you hear the passion in their voices. These leaders are deeply committed to their communities. The patients are often their family, friends, and neighbors, and they understand what it would mean to lose access to care close to home. From the vendor side, supporting them is your way of supporting those communities.
Circe Calvin: Purchased services matter here too. Contract labor usually falls under purchased services, and small hospitals rarely have anyone dedicated to managing it, yet they rely on contract labor for specialized skills. That’s another area to help.
Mark Litton: Absolutely. People assume the big dollars aren’t there. That’s backwards: there’s less competition, and they move fast. If a solution works, they say yes and implement it. Anyone who has sat through a two-year IDN sales cycle would find it refreshing.
And despite the negative press, many of these hospitals are thriving. One of the most common questions we get is how to manage growth, personally and organizationally. They’re adding capabilities and expanding campuses with no blueprint.
Bob Yokl: My in-laws’ town in Pennsylvania has a critical access hospital serving the whole county. They built a new hospital, a medical building, alternate care and skilled nursing beds, and they recruit doctors from other systems. They no longer deliver babies, but they’re making it happen. It’s not all doom and gloom.
Mark Litton: Where the money comes from is exactly what a vetted peer community helps with. At our national meeting in San Antonio two months ago, someone asked who knew about Rural Health Transformation funds and how to access them. About half the hands went up, so half of those supply chain leaders didn’t know the funds existed. That’s why our Circle platform matters: one peer’s comment leads you to discover significant funding for your state, and then to the grant application.
Bob Yokl: I work with cooperatives of community hospitals, and the ideas fly when they ask each other, “Is anybody trying this?”
Bob Yokl: The Independent Link Coalition isn’t top-down best-practice seminars. You built the room and the members lead it. What has surprised you most about its culture?
Mark Litton: I knew these leaders took initiative, but what surprised me was how quickly they took ownership of the community. We provided the structure, and they began setting priorities and organizing the work. There’s a leadership team with chairs for education, membership, supplier partnerships and communications, supported by member subcommittees. It isn’t “let’s meet in a month.” It’s “you do this, you do that, let’s check in next week.”
The thesis also proved correct. We brought 20 supply chain leaders together in Denver in 2025 and asked what support, backed by AHRMM, would look like. Then we built it. We’re now past 100 members. When people don’t work in isolation, they feel supported and get more done.
What was missing was a dedicated nationwide community where supply chain leaders at these facilities could consistently connect and collaborate with peers facing similar challenges. With AHRMM’s support, we’re building that space, and the members get to lead it. Give people that empowerment and they sign up and ask which subcommittee needs help.
Circe Calvin: You shared an example of a California leader building a value analysis program who immediately got templates and best practices from the coalition. Beyond value analysis, what recurring challenge are small hospitals solving together that someone at a large IDN might take for granted?
Mark Litton: Cost savings. Every CEO has a mandate. At large systems, you take it to your GPO, primary and secondary distributors, and they listen because they want to keep the business. An independent hospital has only its own purchasing power, so those conversations are much harder.
Benchmarking is a big need we hear from members: “This item went up 40%. Did everyone’s price go up, or just mine?” With that data, leaders feel empowered to negotiate and focus on the most impactful items.
Circe Calvin: I wish large IDNs could take cost savings for granted; it’s a huge challenge for us too. It’s harder still without resources. At Insights Consulting, I help facilities not only identify savings but implement them and get clinical buy-in for standardization, since savings almost always require standardization to earn better pricing.
Mark Litton: The other thing we’re focused on is the right vendor partners. As soon as you have a group, everyone wants in. So, sponsors are vetted: they must show a real use case and have a member who can vouch for a positive outcome. On our Circle platform we’re building a vendor page with member feedback, what was beneficial, and when a vendor might not fit your facility. Instead of a 30-minute sales pitch, you ask a peer who has already worked with them. Align the incentives across the board and good things happen.
Bob Yokl: I’ll let the cat out of the bag. You shared an analytics tool you offer smaller hospitals for little or nothing. Tell us about it.
Mark Litton: It came from listening, through surveys and feedback, then asking whether I could build it myself and give it away. It’s called Supply Guard. ILC is the peer community for education and collaboration. Howard Medical provides Supply Guard and the purchasing analysis and distribution services I’m describing here.
- How it works: A hospital shares 12 months of purchasing data, every line of every invoice, and gets a customized portal and dashboard.
- Price increases ranked by impact: It shows first price, last price, and the dollar impact based on quantity purchased, sorted by the biggest impact. Supply chain leaders face constant whack-a-mole with hundreds of increases; this shows where to spend their time.
- Vendor discrepancies: When a backorder forced purchases from a second vendor, it shows the cost, for example $30,000 from buying an item elsewhere 15 times a year, so you can push your primary to stock more.
- Contract Guard: It compares purchasing data against signed contracts and flags pricing that doesn’t match. One hospital paid about $5,300 for a product it had under contract for $1,850, overspending roughly $60,000 on a single SKU because the distributor hadn’t loaded the contract.
- AI chat: Leaders can query their own data, such as “What price increases did I get from this vendor in the last six months?”
Supply Guard is free. Through Howard Medical, we also offer a free cost-savings analysis identifying items where we can save at least 10%. That analysis includes exact-match products and appropriate alternates for the hospital to evaluate and approve. If we can’t find $100,000 or more in annual savings within 72 hours, we donate $1,000 to a charity of their choice. We haven’t had to write a check yet.
Independent hospitals manage many of the same product categories as large health systems, but often without dedicated category managers or the same level of on-site distributor and GPO support. Some members use the tool without doing any business with Howard Medical. I built it for myself first to get better visibility into purchasing data, then realized it would help others.
Bob Yokl: As someone with cost and utilization management software myself, I think that’s great.
Bob Yokl: Looking out a couple of years, what does the healthcare supply chain landscape look like when independent and rural hospitals no longer work in isolation?
Mark Litton: That’s my favorite question. The goal is the single best networking group in the U.S. for supply chain leaders at independent, critical access, and rural hospitals.
You can’t solve wearing a lot of hats; they know that coming in. But you can solve isolation by giving them a community to call when issues hit. That’s step one, and we’re well on the way.
Further out, it’s a voice at the table. Many conversations about U.S. healthcare happen without independent hospitals. Organizations tell me they wanted an independent or critical access hospital leader on a panel but didn’t know anyone, so they changed the topic. I know 50 people who would have crushed that panel. When it comes to rules and regulations, we want to present who this group is and what would help their hospitals.
We’re actively recruiting. If this resonates with you, reach out. We’re growing the leadership and membership teams and keep evolving based on member feedback.
Bob Yokl: How can people reach you?
Mark Litton: Supply chain leaders interested in the Independent Link Coalition can learn more and join at https://independent-link-coalition.circle.so/. For Howard Medical, Supply Guard or a purchasing analysis, you can view the process here: howardmedical.com/independent or email me at mark@howardmedical.com. You can also find me on LinkedIn as Mark Litton. I love connecting with supply chain leaders, learning what they’re working on, and finding how we can grow the industry together.
Listen to the Podcast Here:
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